Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study.

• Published in: Rheumatology
• Main Authors: Hellgren, Karin, Ballegaard, Christine, Delcoigne, Bénédicte, Cordtz, René, Nordström, Dan, Aaltonen, Kalle, Gudbjornsson, Bjorn, Love, Thorvardur Jon, Aarrestad Provan, Sella, Sexton, Joe, Zobbe, Kristian, Kristensen, Lars Erik, Askling, Johan, Dreyer, Lene
• Other Authors: 1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 2Rheumatology, Theme Inflammation & Infection, Karolinska University Hospital, Stockholm, Sweden. 3Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Hellerup, Denmark. 4Centre for Rheumatology and Spine Diseases, Rigshospitalet - Gentofte, Hellerup, Denmark. 5Department of Medicine and Rheumatology, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland. 6ROB-FIN, Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland. 7Centre for Rheumatology Research, Landspitali University Hospital, and Faculty of Medicine, Reykjavik, Iceland. 8Department of Science and Faculty of Medicine, National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland. 9Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 10Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark. 11DANBIO Registry, Denmark.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press 2022
• Subjects: Lyfjameðferð; Sóríasis; Krabbamein; Tumor Necrosis Factor Inhibitors; Arthritis; Psoriatic; Antirheumatic Agents; Neoplasms; Norway; Iceland
• Online Access: http://hdl.handle.net/2336/622004; https://doi.org/10.1093/rheumatology/keaa828

To access publisher's full text version of this article click on the hyperlink below Objectives: To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA). Methods: From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-naïve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP). Results: We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-naïve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-naïve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1). Conclusion: In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types. NordForsk FOREUM Det Frie Forskningsrad (DFF) DFF -6110-00608 OAK foundation HUCH Institutional grant Finland Finska Lakaresallskapet Swedish Cancer Society Stockholm County Council Swedish Research Council European Commission